connectionthe Official Magazine of the Emergency Nurses Association

March 2013 Volume 37, Issue 3

5 ENA Co-Founder Judith C. Kelleher, 1923-2013

22 No Career Wasted: A Nurse’s Path Back After Substance Abuse

32 Member Finds Paradise Needs Good Teachers

INSIDE FEATURES

All Together, PULL!

Every Bit of Muscle Matters As We Take Bold New Steps

Through AdvocacyPages 14-20

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Official Magazine of the Emergency Nurses Association 3

With Mentoring, We Make Magic

LETTER FROM THE PRESIDENT | JoAnn Lazarus, MSN, RN, CEN

In Greek mythology, Mentor was the

trusted guardian Odysseus appointed

to watch over his son Telemachus

when Odysseus left for the Trojan

War. Mentor played a pivotal role in

the development of Telemachus,

providing encouragement and

practical plans for Telemachus to

deal with his personal dilemmas.

Because of this story, the term

‘‘mentor’’ has taken on the meaning

of someone who imparts wisdom to

and shares knowledge with a less

experienced colleague.

Most of us can think of a more

experienced person in our lives who

has provided information, given

advice, presented us with a

challenge, initiated a friendship or

simply expressed an interest in our

personal development. Very often

our first mentor was a parent or

another relative who taught and

demonstrated some essential

knowledge or understanding.

Now, a mentor is someone who can

help you move to the next level in your

career or view new possibilities, open doors

for you by introducing you to new people,

act as a sounding board and share the good

and bad of their past experiences to

potentially keep you from making the same

mistakes.

Choose WiselyWhat do you look for in a mentor? A

mentor is usually someone you admire and

whose footsteps you might like to follow. A

good mentor possesses all or most of the

following qualities: willingness to share

skills, knowledge and expertise; a positive

attitude and respect as a positive role

model; and a personal interest in the

mentoring relationship. In addition, a good

mentor exhibits enthusiasm for your

interests, values ongoing learning and

growth; provides guidance and constructive

feedback; is respected by colleagues; has

ongoing personal and professional goals;

values the opinions of others and motivates

others by setting a good example. It is

crucial that a good mentor must also have

the desire and time to take on a mentee.

In my own career, I can think of one

person who was important in my decision

to become an emergency department

director. She encouraged me to return to

Dates to Remember

PAGE 4Members in Motion

PAGE 10ENA Foundation

PAGE 11NEW! Ask ENA

PAGE 12Pediatric Update

PAGE 21Ready or Not?

PAGE 26CourseBytes

Monthly Features

March 11, 2013 Deadline for proposed bylaws and resolutions for 2013 General Assembly at Annual Conference in Nashville, Tenn.

March 25, 2013 Deadline for faculty course proposals for Leadership Conference 2014 in Phoenix (March 5-9, 2014).

PAGE 5Judith C. Kelleher, 1923-2013

PAGE 6Board Writes: In-Flight Medical Emergencies

PAGE 8ENA’s Resource Pathway to Safe Practice, Safe Care

PAGES 14 - 20Advocacy Section

14 Ohio Efforts Pay Off With New Law Against Assaulting Health Care Workers

16 ENA Hosts Its First Emergency Nursing Advocacy Intensive

18 We’ve Come a Long Way, Baby — Or Have We?

20 New ENA Advocacy Department

PAGE 22No Career Wasted: A Member’s Path Back From Workplace Substance Abuse

PAGE 30The AEN EMINENCE Program

PAGE 32ENA Member Finds Paradise Needs Good Teachers

ENA Exclusive Content

Continued on page 28

Steve Stapleton, PhD, RN, CEN, the

immediate past president of the Illinois

ENA State Council and an assistant

professor at Illinois State

University’s Mennonite

College of Nursing, has

received a Nurse

Educator Fellowship

from the Illinois Board of

Education.

The award is aimed at retaining top

nursing faculty at Illinois nursing

colleges and universities. It includes a

$10,000 grant for continuing research.

Stapleton’s research centers on

managing pain for emergency

department patients, particularly after

discharge, with the goals of better

practice, better outcomes and fewer

readmissions. Self-described as a ‘‘strong

proponent of lifelong learning,’’ he

previously has received research grants

from the ENA Foundation and the

National Institutes of Health. His findings

have been published in the Journal of

Emergency Nursing, the Journal of

Clinical Nursing and the Journal of Pain

and Symptom Management.

He’s been at Mennonite in a tenure

track since 2010.

‘‘It is through my own academic

achievement,” Stapleton wrote in his

fellowship application, ‘‘that I will

accomplish my objectives while

inspiring others to seek rewarding

professional and/or academic careers.’’

THREE ENA MEMBERS AT THE

University of Texas Medical Branch in

Galveston were among 11 co-authors of

an article on UTMB’s revised annual

evaluation process.

Valerie Brumfield, MSN, RN, CCRN, a

clinical nurse specialist in the emergency

department; Leanne Ledoux, BSN, RN,

CEN, SANE, the assistant nurse manager

in the ED; and Ruth A. Sathre, MSN, RN,

CEN, a former ED staff nurse who’s now

in the Doctor of Nursing Practice

program at Walden University, helped to

develop ‘‘Enhancing RN Professional

Engagement and Contribution: An

Innovative Competency and Clinical

Advancement Program,’’ which was

published in June 2012 in Nurse Leader.

The article describes the revision

process, which involved a new system

for bedside staff evaluations across

diverse settings and specialties.

Make time in March to slide up to

your computer and take ENA’s latest

free continuing education course.

‘‘GU: It’s More Than Just P,’’ by

Michael D. Gooch, MSN, RN, CEN,

CFRN, ACNP-BC, FNP-BC, EMT-P, is

an e-learning program worth 1

contact hour. It reviews the anatomy

and physiology of the genitourinary

tract, the clinical manifestations

associated with common GU

disorders and patient management.

To take this and other courses in the

CE catalog:

• Go to www.ena.org/freeCE,

where you’ll log in as an ENA

member (or create a new

account).

• Add desired courses to your

cart and ‘‘check out’’ (courses

are completely free for

members only).

• Proceed to your Personal

Learning Page to start or

complete any course for which

you have registered or to print a

certificate when you’re done.

• To return to your Personal

Learning Page at a later time,

go to www.ena.org and find

‘‘Go to Personal Learning

Page’’ under the Courses &

Education tab.

If you have questions about any

free e-learning course or the

checkout process, e-mail

elearning@ena.org.

ENA Connection is published 11 times per year from January to December by: The Emergency Nurses Association

915 Lee Street Des Plaines, IL 60016-6569

and is distributed to members of the association as a direct benefit of membership. Copyright© 2013 by the Emergency Nurses Association. Printed in the U.S.A.Periodicals postage paid at the Des Plaines, IL, Post Office and additional mailing offices.

POSTMASTER: Send address changes to ENA Connection915 Lee StreetDes Plaines, IL 60016-6569ISSN: 1534-2565Fax: 847-460-4002 Website: www.ena.orgE-mail: connection@ena.org

Non-member subscriptions are avail-able for $50 (USA) and $60 (foreign).

Editor in Chief:Amy Carpenter AquinoAssistant Editor:Josh GabyWriter:Kendra Y. MimsEditorial Assistant:Renee HerrmannBOARD OF DIRECTORSOfficers:President: JoAnn Lazarus, MSN,

RN, CENPresident-elect: Deena Brecher,

MSN, RN, APRN, ACNS-BC, CEN, CPEN

Secretary/Treasurer: Matthew F. Powers, MS, BSN, RN, MICP, CEN

Immediate Past President: Gail Lenehan, EdD, MSN, RN, FAEN, FAAN

Directors:Kathleen E. Carlson, MSN, RN, CEN,

FAEN Ellen (Ellie) H. Encapera, RN, CEN Marylou Killian, DNP, RN, FNP-BC,

CENMichael D. Moon, MSN, RN, CNS-CC,

CEN, FAENSally K. Snow, BSN, RN, CPEN, FAENJoan Somes, PhD, MSN, RN, CEN,

CPEN, FAENKaren K. Wiley, MSN, RN, CEN

Executive Director: Susan M. Hohenhaus, LPD, RN, CEN, FAEN

Member Services: 800-900-9659

WHAT’S NEW WITH YOU?E-mail connection@ena.org to

tell us about your recent successes or

to celebrate those of a member

colleague. Include names, credentials

and, if applicable, photos of the

nurse(s) being recognized.

Fellowship Adds Fuel to Illinois Nursing Leader’s Research

Her Dream Lives On

Sometimes, it only takes a handful of people with courage to step out on faith

and create a change … those who dare to dream big for what they believe in . . . those who spark a revolution to improve the lives of others.

For ENA it took two, and one of them was Judith Kelleher. Judy has touched the lives of many, and she has left an imprint on our organization and in our hearts. There are no adequate words to express how grateful we are for the contributions she has made to our profession.

She joined forces with Anita Dorr, RN, FAEN, and they formed the national Emergency Department Nurses Association in December 1970. After Anita’s passing in 1972, Judy carried on their shared vision. She was undaunted by obstacles and determined that emergency nursing would be recognized as a specialty.

She famously said, ‘‘I think the thing that typifies ENA in those early years is that we began to speak out and speak up for emergency nursing, for emergency nursing education, for emergency nursing recognition.’’

Judy led the organization to national prominence and recognition as the only

association dedicated to the advancement of the specialty through education and advocacy. One of her dreams was realized in 2012 when the American Nurses Association recognized emergency nursing as a specialty.

More than 40 years have passed since its creation, and every single member of ENA is still impacted today by Judy’s accomplishments. As an organization, we are truly blessed

to have been founded by a true leader and trendsetter whose dream raised the standards of how we practice. As individuals, we are inspired by her dream to make a difference in the lives of patients and emergency nurses everywhere.

It is a blessing that Judy was able to see the difference she made in our organization … from the 40,000 emergency nurses who have united to become a voice in our profession to the thousands of patients who are receiving better treatments in emergency departments around the country because of her passion to improve emergency care for everyone.

As one ENA member wrote on our Facebook page this week, ‘‘Rest in peace, Judith. Your work here may be done, but your legacy will live on for generations.’’

ENA Co-Founder Judith C. Kelleher

MSN, RN, FAEN

1923-2013

Official Magazine of the Emergency Nurses Association 5

Look for an expanded tribute to the career and impact of Judith C. Kelleher in the May issue of ENA Connection.

Below is an excerpt of the eulogy that Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN,

2013 ENA president-elect, delivered at services for Judith C. Kelleher on Feb. 1.

March 20136

In-Flight Medical Emergencies

Ding! ‘‘If there is doctor, nurse,

paramedic or anyone with medical

training on board who can assist with

a medical emergency, please ring your

flight attendant call bell.’’

When emergency nurses hear this

request, some may hope someone else

will ring in; however, there is no

guarantee of a physician being on

board, which occurs between 40 and

90 percent of the time.

Commercial aircraft emergencies

occur daily in the United States, in

roughly 1 in 39,600 passengers. It is

difficult to clarify the actual number of

medical emergencies due to a lack of

mandated reporting.

Emergency nurses who hear the

call to assist may be the most prepared

based on our knowledge and skill. In

my experiences assisting patients

requiring in-flight medical intervention,

I have found that the term ‘‘doctor’’

can be applied to an array of positions,

including emergency physician,

Doctorate in Public Health Quality,

podiatrist, pediatrician, dentist and

chiropractor. Ascertaining a doctor’s

specialty will better prepare a team to

care for an in-flight patient. Incorporate

the flight attendants into your care, as

they have the direct link to the captain,

who is the ultimate decision-maker

and has contact with ground medical

control.

Medical emergencies that occur

during flight are often related to travel

or stress. Hypoxia, barometric pressure

changes, temperature changes,

dehydration, noise, vibration and

fatigue are environmental conditions

causing physiological stress. Along

with these factors come the signs and

symptoms of nausea, vomiting,

headache, abdominal pain, dizziness,

hypotension and syncope. Although

other medical conditions, such as

myocardial infarction or stroke, can

occur at any time, most in-flight

medical emergencies are related to the

environment and stress of travel.

What do you do? First, make

yourself known to the flight attendant.

Once you have been escorted to the

patient and have made your initial

assessment and general impression,

ask if the patient can be moved to a

more quiet and confidential area, such

as the bulkhead or rear of the cabin. If

this is not an option, ask the flight

attendant to try to reseat passengers or

allow your patient to walk the aisles so

you can best complete a confidential

assessment. Based on the medical

complaint and condition, your patient

may need to lie as flat as possible

across three seats. Do not be afraid to

ask for comfort packages that include

a pillow and blanket.

Today’s airlines in the U.S. are

equipped with an automatic external

defibrillator and robust medical kit,

thought they are kept under lock and

key. Basic equipment, such as a blood

pressure cuff, stethoscope and oxygen,

is readily available. Additional

equipment and advanced cardiac

equipment, not limited to IV solutions

and medications, are available for use

with consultation through ground

medical control. Under Federal

Aviation Regulations, Appendix A to

Part 121, airlines must display the

required equipment. Many airlines

carry additional equipment, including

obstetrical kits and anti-nausea and

over-the-counter pain medications.

A question of liability often arises.

Congress passed the 1988 Aviation

Medical Assistance Act, which allows

medical professionals to operate under

their scope of practice as long as the

professional is practicing in good faith.

According to the Act, ‘‘An individual

shall not be liable for damages in any

action brought in by Federal or State

court arising out of acts or omissions

of the individual in providing or

attempting to provide assistance in the

case of an in-flight medical emergency

unless the individual, while rendering

such assistance, is guilty of gross

negligence or willful misconduct.’’

While rendering medical care, you

should never feel alone. Flight

attendants are trained in first aid and

CPR/AED and welcome any assistance.

Ground medical control is available

through the captain as a joint decision

is made whether to continue to the

final destination or divert. Many times,

with comforting medical and nursing

care, patients make it to their

destination to awaiting EMS personnel.

Next time you answer the ding

asking for assistance, your flight crew

will be quite appreciative, and you

may even receive a token of gratitude

for your willingness to help.

BOARD WRITES | Matthew F. Powers, MS, BSN, RN, MICP, CEN, ENA Secretary/Treasurer

Visit www.ENAFoundation.org for more detailed information on the State Challenge campaign and for updates on

where your state stands in the challenge race.

The Goal is SimpleHelp emergency nurses get the education they need.

Shout out for the future of your profession by making a donation to the ENA Foundation.

Your donation will help your state council’s chances towards the following awards.

Challenge AwardsLargest percentage increase per capita:

1st Place - $250 ENA Marketplace gift certificate2nd Place - $100 ENA Marketplace gift certificate

Largest number of individual donations per state:

1st Place - $250 ENA Marketplace gift certificate2nd Place - $100 ENA Marketplace gift certificate

Donate Now

EN

A F

oun

dation

2013 State Ch

alleng

e

Emergency Nursing EducationSHOUT Out for

Emergency Nursing

Education

2013_ENAF_StateChallengeAd_fullpg.indd 1 1/30/13 1:32 PM

March 20138

ENA’s Resource Pathway to Safe Practice, Safe Care

ENA’s Strategic Plan for 2012-2014 includes four priority

areas that benefit the stretcherside nurse and contribute

to providing safe practice, safe care. Those priorities are

1) advancing emergency care at home and abroad; 2)

advocating for a culture of safe practice and safe care; 3)

championing for a culture of inquiry, learning and

collaboration within our profession; and 4) expanding

and fortifying ENA’s membership. One integrating

concept that encompasses these four philosophies is the

sharing of pertinent information on patient care, patient

and staff safety and a means to further the specialty of

emergency nursing.

Access to EducationTo strengthen the nurse’s ability to provide safe practice,

safe care, ENA provides education in both formal and

informal ways, has developed a scope and standards for

the emergency nurse and offers a wealth of information

through products available at the ENA Marketplace

(admin.ena.org/store). ENA provides educational

programs to support and strengthen the excellent care

delivered by emergency nurses. Courses, seminars and

conferences are based on knowledge from experts in

the field and designed to help you achieve your

professional development goals.

ENA’s Center for e-Learning provides on-demand online

courses through its learning management system. Each

month, a new online course is launched and is free to all

members as a value-added benefit and for continuing

education credits.

ENA’s Annual Conference is the largest educational

gathering for emergency health care professionals. It is a

comprehensive learning experience designed to enhance the

knowledge and skill level of emergency nurses, nurse

managers, ED directors, clinical educators and more. ENA’s

Leadership Conference is the premier educational gathering

for emergency health care leaders, which offers an

unparalleled learning experience, networking opportunities

and exposure to the most cutting-edge tools and products in

emergency care services.

Member ResourcesThe Journal of Emergency Nursing, the official journal of

ENA, reaches the greatest number of emergency nurses,

emergency/trauma departments and ED managers of any

journal. The journal covers practice and professional issues,

based on current evidence, that challenge emergency nurses

every day and features original research and updates from

the field. ENA’s news magazine, ENA Connection, is

published 11 times annually and provides current

information on association activities and emergency nursing

issues.

Emergency Nursing Scope and Standards of Practice is a

landmark publication that describes the competent level of

behavior expected for nurses practicing in the specialty of

emergency nursing. The book provides a guide for the

practitioner to understand the knowledge, skills, attitudes

and judgment that are required for practicing safely in the

By Dale Wallerich, MBA, BSN, RN, CEN, Senior Associate, ENA Institute for Quality, Safety and Injury Prevention

An attendee taps into one of the educational opportunities that have come to define ENA’s annual Leadership Conference.

Official Magazine of the Emergency Nurses Association 9

emergency setting. This book is available at the ENA

Marketplace (admin.ena.org/store) along with a full

selection of resources covering a wide range of the topics in

the practice of emergency nursing.

ENA continues to share pertinent information through its

position statements, which ENA defines as an assertion of

the beliefs held, encouraged and supported by ENA.

Position statements provide concise information and material

for understanding and analysis of the problem. Joint and

consensus position statements are an assertion of the beliefs

held, encouraged and supported by ENA developed in

collaboration with external professional organizations with

mutual interest in providing safe practice, safe care. All

position statements are written in accordance with the

bylaws, strategic plan and code of ethics of the organization

and are officially endorsed by ENA as authorized by the ENA

Board of Directors.

Emergency nursing resources are evidence-based

documents that facilitate the application of current evidence

into everyday emergency nursing practice. ENRs are created

following a rigorous process included in ENA’s Guidelines

for the Development of Evidence-Based Emergency Nursing

Resources. ENA believes that ENRs have a positive impact on

patient care and emergency nursing practice by bridging the

gap between practice and currently available evidence.

New ToolsENA Practice References are a new resource from ENA. They

are succinct practice statements that are based on current

scientific evidence available at the time the documents are

developed. They are related to a clearly identified

circumstance and provide best practice information. They

are not meant to be a substitute for a nurse’s best judgment

in a given situation of care.

The concept of the practice reference came out of the

need to respond to member requests for a quick resource

that can assist in applying appropriate or available evidence

in a given clinical situation. It is anticipated that many of the

practice reference topics will come from ENA listserv

discussions and direct e-mail inquiries.

Two of the several EPRs drafted by the ENA Clinical

Practice Committee in 2012 were reviewed and approved by

the ENA Board of Directors. These first two practice

references focus on hemolysis and right-sided/posterior

ECGs and are available at www.ena.org/IQSIP/Practice/

Pages.

Topic Briefs are informative documents that provide

detailed, accurate and current information on a given subject

of importance to safe practice, safe care. The subjects

selected for topic briefs come from inquiries from members

or as a result of committee work on a particular subject.

Two Topic Briefs, one on health information technology and

the other on health literacy, are currently available at

www.ena.org/IQSIP/Practice/Pages/, along with other

informational tools available for download.

Reference

Emergency Nurses Association. (2012). ENA strategic plan

2012 - 2014 and beyond. Retrieved from www.ena.org/

about/Documents/ENAStrategicPlan2012-2014.pdf

Contributing: Kathy Szumanski, MSN, RN, NE-BC; Jessica

Gacki-Smith, MPH; Altair Delao, MPH; Maureen Howard

and Bree Sutherland.

POSITION STATEMENTSwww.ena.org/about/position

EMERGENCY NURSING RESOURCESwww.ena.org/IENR/ENR

OTHER USEFUL LINKS

www.ena.org/COURSESANDEDUCATION

www.ena.org/publications/jen

www.ena.org/publications/connection

admin.ena.org/store

EMERGENCYCARE SUMMIT

A NATIONAL CONFERENCE FOR EMERGENCY DEPARTMENTNURSES, PHYSICIANS AND PHYSICIAN ASSISTANTS

SNOWMASS, CO

Register online at www.ContemporaryForums.com

Or By Calling 800-377-7707

July 21-24, 2013

EARN UP TO 17.5 CE HOURS

March 201310

Hello, fellow ENA members. I am Julie Jones from South

Carolina, and it gives me great pleasure to introduce myself

as your 2013 ENA Foundation chairperson.

Many years ago, as a member of the South Carolina state

council, I knew I wanted to make a difference in emergency

nursing. My colleagues and I realized we had the

opportunity to give back and do more for others by giving

to the ENA Foundation through the State

Challenge. After the loss of a colleague,

Antoinette Ruff-Johnson, BSN, RN, CEN,

we all wanted to do something in her

honor. Raising money to name a state

council scholarship after her was the

perfect idea. We asked how much we

needed to raise through the State

Challenge to name a scholarship, and

sticker shock hit when we learned the

amount was $5,000. How was our

little state with 500 members going to come up with that

much? We continued passing the hat for the State Challenge

but knew that would not be enough. One chapter donated

10 percent of the proceeds from its oyster roast. We began

e-mailing members in South Carolina, telling the story of

what and why we were doing this. I expanded my e-mail

requests to friends and family, who gladly contributed. Our

state council also informed Ruff-Johnson’s family of our

intentions, as well as her former emergency department, to

encourage donations in her honor.

We succeeded and named our first scholarship in 2011.

I am happy to say that we were able to sustain the how

and why of gaining donations and named the Antoinette

Ruff-Johnson Memorial Scholarship in 2012. I share this story

to show that even a smaller state can make a great

contribution and honor someone who has touched its

members’ lives.

South Carolina is not the only small state to have made

this commitment. Mike Hastings, MS, RN, CEN, of the Kansas

ENA State Council (membership: 393) shared KENA’s story

with me.

‘‘We join the Foundation’s focus to expand the

knowledge of emergency nurses by offering education,

scholarships and funding research opportunities,’’ he said.

KENA members do this in several ways. First, they pass

the hat at each state meeting. Second, they purchase jewelry

from the ENA Foundation Jewelry Auction at the Annual

Conference. At each state meeting, members can buy tickets

for chances to win the jewelry. Most recently, Kansas

honored one of its members, Darlene Whitlock, MSN, MA,

RN, APRN, ACNP, EMT-B, CEN, CPEN, by naming a

scholarship after her. Members wanted to do something

special to recognize her efforts in Kansas

regarding the trauma system, as well as

her years of dedication and service to the

Kansas ENA Board of Directors. State

Council and chapter contributions made

this possible.

Seleem Choudhury, MSN, RN, CEN,

the ENA Foundation chairperson-elect,

shared how the Colorado ENA State

Council (membership: 860) conducted its

successful fundraising effort the last few

years. In 2010, Colorado ENA began its journey to becoming

more involved in the ENA Foundation. Before then, the

council had not contributed; when Choudhury became

council president, he made it a priority.

Colorado ENA started with simply making an ENA

Foundation donation a line item in its budget and its

strategic plan. It noticed a corresponding increase in

individual donations. Colorado did some unique fundraising

as well. It purchased 20 CEN review manuals, sold them at a

discounted rate and gave 100 percent of the proceeds to the

ENA Foundation. At its state conference, it asked for ENA

Foundation donations at its state booth.

At the end of 2011, Choudhury went to the board with the

idea of increasing the donation for 2012 to $5,000 to name a

scholarship. This will be given out in 2013 in remembrance

of the victims of the Aurora movie theater shooting.

Every state has a story. Now is the time to tell your story

and connect it to your purpose by giving to the ENA

Foundation. Let’s support our profession and each other.

Reach out to other state chapters to brainstorm fundraising

ideas. I can’t wait to hear about some of your ideas as we

strive to make the 2013 ENA Foundation State Challenge the

most successful ever. For more information on the State

Challenge and how you can contribute to the ENA

Foundation, please visit www.enafoundation.org.

Mike Hastings, MS, RN, CEN (left) and Seleem Choudhury, MSN, RN, CEN, of the Kansas and Colorado state councils.

The Many Ways We Can Do More

ENA FOUNDATION | Julie Jones, BSN, RN, CEN, 2013 ENA Foundation Chairperson

Q: I am an ED nurse finishing up

my bachelor’s degree in nursing,

and I plan on pursuing a master’s

degree. I have heard about forensic

nursing, and it has intrigued me. Is it

a female specialty due to the high

percentage of female sexual assaults?

Would a male have the same

opportunities afforded to him?

– Jared from Boston

A: Jared, thank you for reaching out

to ENA. The term ‘‘forensic nurse’’ is

relatively new — the field has only been

around for approximately 20 years.

Because forensic nursing encompasses a

wide variety of issues, gender really

does not matter.

A forensic nurse is a nurse with

specialized training in forensic evidence

collection, criminal procedures, legal

testimony expertise and much more as

the job description continues to expand.

Other career branches for this job

outside of the hospital include medical

expert witness, nurse death investigator

and community education.

If you decide to stay within the

hospital setting, you may share your

expertise with your peers to help them

provide not only quality care but expert

documentation for the patient who has

been injured, assaulted or abused.

There are numerous master’s degree

programs across the country, with

several on the East Coast that specialize

in forensic nursing. I would encourage

you to contact the International

Association of Forensic Nurses at iafn.

org to find out more about the specialty

and to seek their assistance in finding

an advanced program that meets your

needs.

I hope I have answered your

questions. Please feel free to contact me

at dwallerich@ena.org.

— Dale Wallerich, MBA, BSN, RN, CEN, Senior Associate,

ENA Institute for Quality, Safety and Injury Prevention

In response to member requests

for more interactive opportunities,

ENA Connection is proud to debut

its newest feature, Ask ENA.

Members are encouraged to submit

questions about the organization

and emergency nursing in general.

Questions should be no longer

than 200 words. For verification

purposes, you must include your full

name, address and e-mail address.

(We will accommodate requests to

not print full names.)

Questions will be referred to the

appropriate ENA staff or department.

Submission of a question does not

guarantee publication. Submissions

may be edited for clarity or

shortened for space.

E-mail questions to

connection@ena.org, fax to

847-460-4005 or mail to ENA

Connection, 915 Lee St., Des Plaines,

IL 60016.

Job seekers can post their resume, search for jobs and most importantly create an online profile for employers to find. You can maintain total privacy about your job search by selecting to keep your resume and profile confidential in our database.

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March 201312

Fact: Children get hurt and often require minor procedures

performed in the emergency setting.

Fact: Simple strategies can eliminate or drastically reduce

pain in pediatric minor procedures.

Pediatric pain is often under-recognized and undertreated

in the emergency setting. One study examining more than

1,000 pediatric patients undergoing minor procedures found

that almost none of the children received any pain

management strategies.1 Children can have long-lasting

negative psychological effects from a painful procedure.

Infant males who were circumcised shortly after birth

without pain control demonstrated higher levels of pain

when receiving their infant immunizations.2 Using simple

strategies can reduce pain and fear while increasing child

and parent satisfaction.

Evidence confirms that parents should be permitted to stay

with their children when undergoing minor procedures.3

Parental presence is helpful for children, yet it is not

consistently implemented. Parents should be provided

instructions on how to help maintain a calm and positive

atmosphere along with suggestions for distraction

techniques.

The position of the child can make a significant difference

in the child’s stress during the procedure. Comforting

positions, such as the child sitting in the parent’s lap or sitting

in the “chest-to-chest” position with the parent (see Figure 1),

provide positive support as opposed to having the child lie

supine, which often results in panic and struggling.

Words can either comfort the child or invoke fear.

Warning a child about anticipated pain often results in greater

pain and anxiety in the child. Reassuring comments, such as

‘‘You can do this’’ or ‘‘Don’t worry’’ can increase distress in

children and should be avoided. Avoid telling the child what

you do not want the child to do: ‘‘Don’t move,’’ which can

also evoke fear in the child. Instead, tell the child what you

want him or her to do: ‘‘I want you to try to hold your arm

very still and take some deep breaths like Mommy.’’

Distraction can direct the child’s attention away from the

pain related to the procedure. Distracters such as books,

toys, music, video games, singing and deep breathing should

be developmentally appropriate and able to capture the

child’s interest. The I-Spy book series is an excellent

distracter for children. Talking and touch have been found to

be the most helpful distracters.

The application of pressure (rubbing near the site or

vibration in close proximity to the location where the

PEDIATRIC UPDATE

Reducing Needless Pain in Pediatric Minor Procedures

By Denise R. Ramponi, DNP, NP-C, CEN, FAEN, Assistant Professor, Robert Morris University, and Nurse Practitioner, Heritage Valley Sewickley Emergency Department, Pittsburgh ♦ Edited by Elizabeth Stone Griffin, BS, RN, CPEN

Figure 1: Mother holding child in the “chest-to-chest” position.

Fewer Tears and Fears

Official Magazine of the Emergency Nurses Association 13

procedure is being

performed) can also be

an effective method to

reduce pain. This

method demonstrates

use of the Gate Theory,

similar to the method

used by dentists who

jiggle the lip before

giving intraoral

injections.

There are a number

of non-invasive agents

that can be used to

reduce pain in the

emergency setting.

Some can be applied

immediately prior to

procedures, and others

must be applied 20 to

30 minutes in advance

of a procedure to

engage maximum

benefit. Topical

vapocoolant spray is

an anesthetic skin refrigerant that instantly reduces pain for

needlesticks and other skin punctures. It can be applied to

minor open wounds or intact skin (such as abscesses). It is

sprayed for 4 to 10 seconds or until the skin is blanched,

with a resultant 60 seconds of transient anesthesia to

perform the procedure. Liposomal lidocaine

(4 percent) cream can be applied to intact skin to reduce

pain from venipunctures. It can be placed over two areas

where the vein is most prominent, often the antecubital area

and dorsum of the hand, for approximately 20 to 30 minutes

before IV starts. Two areas are typically used in case the first

IV attempt is unsuccessful.

For open wounds, mixtures of lidocaine, epinephrine and

tetracaine can be applied to lacerations in the triage area.

LET is applied to a cotton ball or other nonabsorbent

dressing and taped in place. As an alternative to using tape

over the dressing, the parent can wear a glove and apply

pressure to the dressing over the wound for approximately

20 to 30 minutes before laceration cleansing and repair. The

skin will become blanched from the epinephrine in the LET

(see Figure 2).

Other considerations include application of viscous

lidocaine jelly to the urethra for approximately 10 minutes

before urethral catheterization attempts in infants. Infants

can be provided sucrose solution by dipping a pacifier in the

sucrose and giving it to the infant before, during and after

painful procedures.

The sucrose causes the

release of endogenous

endorphins and thus

reduces the pain.

Infants provided

sucrose were found to

cry less and returned to

their baseline condition

quicker after

procedures. Pacifiers

alone can also be

effective for analgesia.

There are a number

of other pain-reducing

strategies that are

beyond the scope of

this article. The methods

discussed can take a

minimal amount of time

and can significantly

reduce pain effectively

in the pediatric patient.

References

1. MacLean, S., Obispo, J., & Young, K.D. (2007.) The gap

between pediatric emergency department procedural pain

management treatments available and actual practice.

Pediatric Emergency Care, 23(2): 87-93.

2. Taddio, A., Katz, J., Ilersich, A. L., & Koren, G. (1997.)

Effect of neonatal circumcision on pain response during

subsequent routing vaccination. The Lancet, 349(9052),

599-603.

3. Broome, M. (2000.) Helping parents support their child in

pain. Pediatric Nursing, 26(3), 315-317.

Head to enajoann.wordpress.com or

the ENA website, www.ena.org, to read the

latest posts from 2013 ENA President JoAnn Lazarus,

MSN, RN, CEN, in her new ENA President’s Blog.

Figure 2: Skin blanched after 20 minutes of LET application.

BLOG ON

March 201314

On Dec. 20, Ohio Gov. John

Kasich signed Amended

Substitute House Bill 62 into

law. Taking effect March 22, the

Health Care Worker’s Protection

Act will increase the penalty for

assault against nurses and other

health care professionals.

Sponsored by state Rep. Anne

Gonzales (R-Westerville), HB62

is a much-needed first step

toward reducing the incidence

of violence in Ohio’s hospitals.

Key elements of the new law

are illustrated in the table below.

‘‘Nurses and other hospital

health care workers now have

the opportunity and safeguard to

keep the work environment a

safer and more secure place to

deliver care,’’ said Beverly Clensey, MS,

RN, CCRN, CEN, immediate past

president of the Ohio ENA State Council.

The passage of HB62 is the

culmination of several years of work by

the Ohio Emergency Nurses Association

and the Ohio Nurses Association. Our

grassroots passion for the topic and

expertise on the phenomena, combined

with the political power of ONA, proved

a most successful coalition. Letters of

support also were received from the

Ohio Hospital Association, American

College of Emergency Physicians, Ohio

State Medical Association and the Ohio

chapter of the American Psychiatric

Nurses Association.

State Sen. Scott Oelslager, then-chair

of the Senate Health Committee and

sponsor of companion legislation Senate

Bill 111, was instrumental in the bill’s

successful 18-month journey through the

Ohio Senate. Oelslager

recognized Ohio ENA

during a Nov. 27 debate on

HB62 on the Senate floor by

saying, ‘‘In particular, I

would like to thank and

recognize the Ohio

Emergency Nurses

Association. The statistics,

research and national

expertise they brought to

the table on this issue was

incredible.’’

In addition to strong

work by Ohio ENA, the

actions of our individual

members largely contributed

to HB62’s passage. The

table on the next page lists

the individual members

who provided HB62 proponent

testimony. In particular, Central Ohio

emergency nurse Libby Robb, RN,

testified before the Senate Judiciary’s

hearing on companion legislation

(SB111) to share her tearful experience

of being assaulted by a patient. With the

help of Ohio ENA member Gordon

Gillespie, PhD, RN, CEN, CPEN, FAEN,

we brought national expert Donna

Gates, EdD, MSPH, MSN, FAAN, to

testify before the Senate Judiciary’s

hearing on HB62. Also, an article by

ENA past president Diane Gurney, MS,

RN, CEN, FAEN, in the April 2011 issue

of ENA Connection was a catalyst to

introduce language in the bill permitting

standardized hospital signage on the

issue.

‘‘All emergency nurses are indebted

to the Ohio Emergency Nurses

Association, the Ohio Nurses

Association, Rep. Gonzalez and Sen.

By Nicholas Chmielewski, MSN, RN, CEN, NE-BC, Ohio ENA State Council Government Affairs Liaison

Ohio Efforts Pay Off With New Law Against Assaulting Health Care Workers

Key Elements of HB62• Directs the Ohio Department of Health to create standardized signage in the

shape of a stop sign. The signage will state that abuse or assault of hospital

staff will not be tolerated and could result in a felony conviction. Authorizes

hospitals to post the signage in public areas.

• If the hospital offers de-escalation training to its staff, HB62:

° Authorizes a $5,000 fine for assault against healthcare professionals, health

care workers and security officers of a hospital for a first-time offense.

° Increases the penalty for assault to a fifth-degree felony when the offender

has previously been convicted of an assault against a health care worker.

ADVOCACY

Pictured at the signing of HB62 with Ohio Gov. John Kasich (seated) are (from left) state Rep. Anne Gonzales; Ohio ENA State Council Immediate Past President Beverly Clensey, MS, RN, CCRN, CEN; Ohio ENA Government Affairs Liaison Nicholas Chmielewski, MSN, RN, CEN, NE-BC; state Sen. Scott Oelslager; and ONA President Paula K. Anderson, RNC.

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• Quality improvement programs and acti viti es

• Content experti se on the scope of emergency nursing practi ce

• And American Nurses Associati on now recognized emergency nursing as a speciality

Oelslager for all their work on

this legislation,’’ said Gail

Lenehan, EdD, MSN, RN, FAEN,

FAAN, immediate past president

of ENA. ‘‘The legislation will help

to protect the nurses of Ohio, but

also provides inspiration for

similar legislation in other states

as well. Importantly, it sends a

message that will hopefully be

heard beyond the boundaries of

Ohio — that violence against

nurses and other health care

workers will not be tolerated,

that it is no more acceptable than

violence against police or firefighters.’’

It took the introduction of many

bills over several sessions to realize the

passage of HB62. In the 128th Ohio

General Assembly, state Rep. Denise

Driehaus introduced HB450 to restart

the conversation. Similar legislation

was introduced in that session by Rep.

Stephen Slesnick and then by

Oelslaeger. In the 129th Assembly,

Slesnick and Driehaus re-introduced

legislation. There were several

discussions and changes to HB62

during its journey to becoming law.

Key discussions included:

• The philosophy of ‘‘protected classes.”

• Explaining the need for this

legislation and helping legislators

understand the prevalence of this

violence.

• Explaining that this bill is not about

‘‘locking up’’ an elderly patient with

Alzheimer’s or a patient waking up

from anesthesia in a combative state.

• The scope of who should receive

protection.

• Individuals under the influence of

drugs or alcohol.

• Individuals with mental

impairments.

• The degree of penalty that

should be applied to offenders.

• Hospitals’ responsibility to

provide de-escalation training.

• The need for signage to

promote awareness and

discussion on the issue.

• The cost of implementation.

We were extremely grateful for

the expertise, support and

guidance of ENA’s national office

staff during the last several years.

This support was highlighted when

Lenehan joined us at the Ohio State

Capitol to celebrate HB62’s signing.

One important lesson learned is that

successful legislative policy requires

collaboration and compromise. Most

important, however, is persistence. It

was the unrelenting persistence of our

members — through letter-writing and

phone calls — that resulted in HB62

receiving a crucial floor vote in the

Senate. To each of our members across

the state who contributed, I say thank

you and congratulations!

Emergency Nurses Contributing at HB62 Hearings

House Criminal Justice, April 2011

Dan Abbey ♦ Tammy Brassler ♦ Nancie Bechtel ♦ Nick Chmielewski ♦

Ivy Cook ♦ Meghan Long ♦Nicole McGarity

Senate Judiciary, November 2011

Nick Chmielewski ♦ Beverly Clensey ♦Megan Long ♦ Nicole McGarity

March 201316

More than 90 ENA state council leaders representing more

than 30 states attended ENA’s first Emergency Nursing

Advocacy Intensive in Chicago on Jan. 10-12. Sponsored by

Vidacare, this unique event provided attendees with an

exciting opportunity to learn more about advocating for the

emergency nursing profession to make a difference for their

patients and colleagues.

The three-day event kicked off with a welcoming

reception at ENA national headquarters, where attendees

were able to reconnect and network with their peers. 2013

ENA President JoAnn Lazarus, MSN, RN, CEN, opened the

second day with a presentation on ENA’s priorities and its

2013-2014 Public Policy. She explained that the ENA Board

of Directors determined that the new ENA Public Policy

would be more nurse-focused.

‘‘This is an organization about you and advocating for all

of you,’’ Lazarus said. ‘‘We know that safe practice advocates

for safe care. By taking care of all of you, you’ll be able to

take care of your patients.’’

Lazarus discussed the meaning of her newly coined term

‘‘advocatism’’ and the importance of image, from appearance

to communication.

‘‘To me, advocatism is what we do for our patients and

for the profession of nursing. Advocatism is really at the

heart and soul of what we do as emergency nurses,’’ she

said. ‘‘As ENA, we are held in high esteem because of the

image we have with the public and because of the

perception of what we do for others. Advocacy is not just

about influencing public policy. From a nursing image

perspective, it’s our responsibility that the public sees us in

the best light.’’

Attendees learned about the importance of networking

from keynote speaker Laura Schwartz during her ‘‘Eat, Drink

and Empower’’ presentation. As the former White House

director of events for the Clinton administration, Schwartz

shared effective techniques for networking, communication

and mentoring.

‘‘No matter where we are . . . we have opportunity

everywhere we look to be ourselves and empower others

through our own background and stories, as well as to

advocate for ENA in all places, both on and off the clock,

with those professionally in your field and those who are

curious about it,’’ Schwartz said.

Schwartz urged the audience members to attend

conferences and networking sessions to connect with and

build bridges for others. She said networking is the best way

to effectively communicate the message of ENA.

‘‘ENA really provides an incredible bridge for you,’’ she

said. ‘‘ENA has the tools, resources, research and incredible

staff within ENA for you to go to and get that information to

help build that bridge for your hospital, a colleague or in

your community. They are there for you, so use that bridge

when you lobby for that safer work environment. . . . You

are so used to advocating for your patients all day every day,

but you also have to advocate for yourselves. As you

advocate for yourselves, you advocate for every one of your

patients at the same time.’’

‘‘The power of ENA and you the member is amazing,’’

Schwartz continued. ‘‘When you’ve got a critical patient that

you’re administering to, when you’re in the meeting with the

CFO talking about purchasing safer equipment, or when

you’re out in the community to meet with legislators, you’re

not in that room with the patient or on Capitol Hill alone.

You are in there with the other 39,999 members of ENA.

ENA Hosts Its First Emergency Nursing Advocacy IntensiveBy Kendra Y. Mims, ENA Connection

ADVOCACY

JoAnn Lazarus, MSN, RN, CEN, the 2013 ENA president, shares her concept of ‘‘advocatism’’ during remarks on the second day of the Emergency Nursing Advocacy Intensive.

Official Magazine of the Emergency Nurses Association 17

You are never alone.’’

Susan Hohenhaus, LPD, RN, CEN, FAEN, ENA’s executive

director, led an informative session on public relations and

media training. Attendees learned how to effectively work with

the media and connect with their communities. Hohenhaus

discussed two types of media relations (proactive and reactive);

how to deal with print reporters and broadcast reporters based

on their differences; knowing the rules of engagement when

working with journalists; and how to conduct a successful

interview by knowing who you are, what ENA represents and

the definition of an emergency nurse. Attendees learned the

advantages of using the media to advocate.

‘‘Nursing is incredibly well-positioned in today’s health

care environment,’’ Hohenhaus said. ‘‘In order to take care

of your patients, you have to make sure that you’re in a safe

place, that your scope and practice are protected and you’re

able to leverage federal and state funding to actually drive

health care policy. You’re at the beginning of a revolution

that I feel is exciting.’’

Richard Mereu, JD, MBA, ENA’s new chief government

relations officer, discussed the current situation in

Washington, D.C., to raise awareness on becoming effective

government relation advocates. (Learn more about Richard

Mereu and his extensive legislative background on page 20.)

Mereu’s session was followed by the expert panel on

advocacy, which included the following guest speakers:

ACEP Advocacy: Gordon Wheeler, ACEP associate

executive director, public affairs

Nurses CAN 2012: Adrianne Drollette, American Nurses

Association, senior political action specialist

State and Federal Regulatory Agencies Weighing in on

Health Care Scope of Practice: Anna Polyak, JD, RN,

American Association of Nurse Anesthetists, senior director

State Council/Chapter/State Legislative Coordinator

Structure: Amy L. Hader, JD, Association of

periOperative Registered Nurses, director, legal and

government affairs

Vidacare Corporation — Representation of the

Industry Perspective: Michelle Fox, BSN, RN,

Vidacare senior director clinical affairs

Top photo: Jeff Strickler, MA, RN, CEN, CFRN (foreground), and other emergency nurses from around the country take in the messages of the advocacy intensive. Below, left: Michelle Fox, BSN, RN, senior director of clinical affairs for Vidacare, shares industry perspective on the importance of advocacy. At right are Gordon Wheeler, associate executive director of public affairs for ACEP, and Adrianne Drollette, senior political action specialist for the American Nurses Association. Below: Lazarus with keynote speaker Laura Schwartz (center) and ENA Executive Director Susan Hohenhaus, LPD, RN, CEN, FAEN.

Continued on next page

March 201318

We’ve Come a Long Way, Baby … Or Have We?

I was fresh off the

plane from Chicago,

where I spent a

spirit-lifting

weekend with my

ENA peers at the

Advocacy Intensive. Energized and ready

to get to work with my Virginia colleagues

to enable us all to have safe practice and

provide safe care, I was handed a copy of

a 1961 newspaper article titled ‘‘Night in

Emergency Rooms: Hospital Nerve Centers

Stay Alert.”1

The article included photographs of

patients lining the hallway head to feet

while they waited for an intern to evaluate

them further; police, nurses and doctors

huddled around a receiving desk, sifting

through patient information following an

accident. Details of the latest and greatest

technology, the electrocardiogram, which

‘‘produces a photographic record of the

heart’s actions,’’ was highlighted for readers.

My attention was drawn to a section

that outlined the violence that provides the

emergency room with much of our

business and another section that read,

‘‘These are the emergency rooms. These

are the places where lives are saved,

people helped, doctors and staff abused.’’

That sentence really hit home. As a

member of the Virginia ENA State Council

and the Virginia Nurses Association, I

testified before five committees during the

2011 Virginia General Assembly, where HB

1690, a bill that provides some guaranteed

ramification to abusing or hitting any

emergency department worker, was

eventually passed into law. While preparing

to testify on one of the later hearings, I

asked Virginia emergency nurses to share

their stories as to why they did not press

charges after being assaulted in the ED.

One answer especially disturbed me.

This particular nurse was punched in the

face by a patient. She subsequently went

to the magistrate to press charges and was

denied her request because, she was told,

‘‘this was part of her job.’’ Reading this

article and reflecting back on my own

experiences and testimony, I now see why

this abuse is often seen as just part of the

job. Well, it’s not.

Reading this piece led me to ask, ‘‘What

has changed?’’ The answer is not much. In

1961, patients lay on gurneys in hallways

waiting for treatment; violence was a big

part of the reason for visits; and abuse of

staff was a regular occurrence. The real

changes are that patient volume has more

than tripled, technology allows staff to treat

more complex diseases and emergency

nurses and physicians stand united in their

pursuit of safe work environments while

they lobby together, all with the thought of

being able to better serve those in need.

During her opening lecture at the

Advocacy Intensive, 2013 ENA President

JoAnn Lazarus explained advocatism as the

actions around advocating for others. I

submit to you that we all need to take this

to heart and practice advocatism for each

other every day. Don’t let another nurse in

40-plus years read an article that highlights

the waiting and the violence toward ED

staff. We need to change what future

emergency nurses read. Let them see what

you and I did to foster a safe environment

for them and the patients who need our

services each and every day.

Reference

Lindsay, G. (1961, July 23). Night in

emergency rooms: Hospital nerve centers

stay alert. Richmond Times Dispatch.

By Mary Menafra, MSN, RN, CEN

Attendees were able

to share important

issues affecting their

profession and

emergency departments

during the interactive

‘‘What’s Happening in

Your State?’’ session.

The event ended with

informative sessions led

by guest speakers

Hershaw Davis, Jr.,

MSN, RN, the ENA

Government Affairs

Committee chairperson;

Rita Anderson, RN, CEN,

FAEN, ENA Government

Affairs Committee; Lisa

Wolf, PhD, RN, CEN,

FAEN, ENA Institute for

Emergency Nursing

Research director;

Elisabeth Weber, MA,

RN, CEN, ENA

Government Affairs

Committee; Kathleen

Conboy, BS, RN, CEN,

ENA Government Affairs

Committee; and Deena

Brecher, MSN, RN,

APRN, ACNS-BC, CEN,

CPEN, 2013 ENA

president-elect.

Attendees left the

intensive empowered

with knowledge and

strategies to advocate

for their patients and

themselves.

‘‘We have to help the

patient’s voice be

heard,’’ Lazarus said.

‘‘We need to be the

voice of nursing and

inform legislatures. I

look to all of us to be

able to change the

world.’’

ENA Advocacy Intensive Continued from page 17

ADVOCACY

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LC13_Call_for_FacultyAD_Conn_Mag_fullpg.indd 1 1/30/13 1:40 PM

ENA is shaping its new advocacy

department with the hiring of its first

chief government relations officer.

Richard Mereu, JD, MBA, who

began his new position with ENA on

Dec. 24, has worked in Washington,

D.C, for more than 20 years and brings

an extensive legislative background

and congressional experience to ENA.

Susan Hohenhaus, LPD, RN, CEN,

FAEN, ENA’s executive director,

describes the new position as

instrumental in overseeing federal and

state advocacy efforts and government

relations related to emergency nursing.

‘‘This is the perfect time for ENA to

make advocacy for the profession of

emergency nursing a priority,’’

Hohenhaus said, ‘‘and Mr. Mereu is the

perfect professional to begin this

journey with us.’’

Mereu has a JD from Albany Law

School and an MBA from The Wharton

School. He has worked on a variety of

health care issues as chief of staff to

Rep. Elton Gallegly (R-Calif.) and staff

director for two subcommittees of the

House Foreign Affairs Committee, as

well as serving as a professional staff

member on the House Judiciary

Committee. He believes his vast

background is essential to helping ENA

shape the new Advocacy Department.

‘‘Throughout my career I’ve had a lot

of roles and worked on many issues,

everything from health care and budget

issues to criminal law matters and

immigration,’’ he said. ‘‘We were able to

pass several bills that dealt with those

issues and fund programs in those areas.

‘‘I think my background is

important because the issues that ENA

is facing now are so diverse. I know

the legislative process very well from

having worked in Congress for all of

those years. That’s important in terms

of trying to get the initiatives that ENA

cares about passed through Congress.’’

ENA’s mission to advocate for

patient safety and excellence in

emergency nursing practice is one of

the factors that attracted Mereu to the

position. Based in ENA’s Washington,

D.C. office, he looks forward to

working on ENA’s top priorities,

including workplace violence in the

emergency care setting, which he

describes as one of the most ‘‘important

issues affecting the functioning of

emergency departments.’’

‘‘The primary goal is to establish a

very visible presence for ENA on

Capitol Hill, to advocate for our

priorities in Congress and in front of

the whole federal government and to

move forward on legislation to the

benefit of our members,’’ he said.

Mereu had the opportunity to

connect with members at ENA’s

Emergency Nursing Advocacy

Intensive in January when he

presented a session on building

relationships with legislators and

developing an authoritative voice on

Capitol Hill to meet the needs of

patients and emergency nurses.

JoAnn Lazarus, MSN, RN, CEN, the

2013 ENA president, said, ‘‘I look

forward to working with and learning

more from Mr. Mereu about legislative

and regulatory issues and expanding

ENA’s influence.’’

Mereu said his position will allow

him to delve much deeper into health

care issues.

‘‘I’m extremely excited, especially

now that health care reform is passed

and it was upheld by the Supreme

Court last year,’’ he said. ‘‘That will

create opportunities for ENA. Also,

everybody recognizes that the role of

emergency nurses is so important to

our overall health care system, so I’m

starting at a very good time in terms of

being able to get in at the ground floor

as these changes are being implemented

at the federal level. I can really

influence some of the direction that our

health care system is going to go in on

behalf of ENA.’’

March 201320

ENA Shaping New Advocacy Department By Kendra Y. Mims, ENA Connection

ADVOCACY

Richard Mereu, JD, MBA, the new ENA chief government relations officer, uses Skype to confer with staff at ENA headquarters from his office in Washington, D.C.

Official Magazine of the Emergency Nurses Association 21

In an act of defiance and revolution,

representatives of the 13 American

colonies broke from the British

Empire, signing the Declaration of

Independence on July 4, 1776.

Benjamin Franklin’s warning to his colleagues at that signing,

“We must hang together, gentlemen ... else, we shall most

assuredly hang separately,” highlighted the importance of

unity and coalition in the face of overwhelming odds.

Coalitions were crucial for nation-building then and to health

care emergency preparedness today.

Future Needs Joint Commission emergency management standards and the

lessons of Hurricanes Katrina and Sandy and the Joplin, Mo.

tornado remind us that hospitals and their emergency

departments must ultimately plan for overwhelming threat

scenarios requiring them to stand alone or evacuate. The

recent threat of a highly infectious H5N1 pandemic, with its

projected 50 percent mortality rate, would overwhelm most

U.S. hospital intensive care units.

Pandemics have occurred four times during the last 100

years. Concerns for certain and future natural, technological

or terrorism catastrophes are ever present. Emergency

department and hospital capacity and capability must be

maximized and coordinated with community health care

resources.

Nationally, hospitals have been building their surge

capacity and capability by organizing and reaching out to

community health care response partners, forming emergency

response alliances, networks and coalitions. Since 2001,

emergency preparedness, surge capacity and resilience in

U.S. hospitals and health care systems have been facilitated

and supplemented by the mechanisms and associated

funding of the U.S. Department of Health and Human

Services, Office of the Assistant Secretary for Preparedness

and Response Hospital Preparedness Program.

How are health care preparedness coalitions organized,

funded and sustained over time? What benefits are there to

being a member of a health care preparedness coalition?

What are best practice examples of existing coalitions? When

have health care preparedness coalitions lessened or

mitigated emergency department impacts during disasters? To

answer these questions, enter the 2012 National Healthcare

Preparedness Coalition conference.

A Successful ConferenceThe inaugural National Healthcare Preparedness Coalition

conference was held Nov. 26-27, 2012, in Arlington, Va., with

a mission of providing coalition-building strategies and best

practices. Organized and hosted by the Northern Virginia

Hospital Alliance, Seattle King County Healthcare Coalition,

and MESH, Inc. of Indianapolis, the conference was an

opportunity for stakeholders from around the country to

share best practices and lessons learned from building and

sustaining health care coalitions focused on health care

preparedness. Attendees came from Guam and most U.S.

states and included hospital emergency preparedness and

Hospital Preparedness Program grant leadership from local,

state and federal levels.

Attendees included the following ENA members: Elisabeth

Weber, MA, RN, CEN, of Chicago; Doris Neumeyer, BSN, RN,

of Washington, Mich.; Lori Upton, MS, BSN, RN, of Houston;

and Knox Andress, BA, RN, AD, FAEN, of Shreveport, La.

Upton presented “How Coalitions Can Support Recovery

Operations” while Andress shared “How Coalitions Can

Develop Evacuation Plans for Hospitals and Nursing Homes.”

Dr. Nicole Lurie, assistant secretary for Preparedness and

Response, U.S. Department of Health and Human Services,

welcomed attendees to a wide range of intriguing health care

preparedness coalition-building topics and panel discussions,

including the following:

• Building and Sustaining Coalitions

• Crisis Standards of Care

• How Coalitions Support Response

• How Coalitions Can Develop Information Sharing Systems

and Plans

• How Coalitions Can Develop Evacuation Plans for Hospitals

and Nursing Homes

• Engaging Coalition Partners and Participants

• How Coalitions Can Develop Behavioral Health Operations

Plans/Triage

• How Coalitions Can Support Recovery Operations

• ASPR Grant Metrics and Reporting Discussion

READY OR NOT? | Knox Andress, BA, RN, AD, FAEN

Hang Together or Separately

March 201322

Mother Nature’s gift to

Mobile, Ala., on

Christmas Day was a

large EF2 tornado

dropping in on the

downtown. The Mobile Infirmary

Medical Center took a hit: some broken

windows, uprooted trees and

overturned cars. Next door at the

University of South Alabama Children’s

and Women’s Hospital, where ENA

member John Marshall, BSN, RN, is the

3-to-11 supervisor, the tornado did

minimal damage as it rolled past.

No serious injuries were reported in

the community.

‘‘That’s the first time I ever met a

tornado face-to-face,’’ Marshall says in

his easy drawl. ‘‘It had my attention.’’

But as storms go for Marshall, this

was nothing. The biggest and scariest

he’d faced came more than a generation

earlier, some 350 miles away in his

hometown of Macon, Ga.

In April 1985, Marshall, then 34 and

married with a young son, already had

been fired from three area hospitals as

rampant substance abuse ripped a hole

in his life and nursing career.

‘‘This was before the days of

computers,’’ he says, ‘‘so you could still

go next door and get a job and they

didn’t know that you were in trouble

other places.’’

He’d lost a job in an emergency

department the previous year and spent

six weeks in rehab after introducing

methamphetamines into a buffet of

drugs that already included marijuana,

booze and pills. Now he was working

in a different hospital’s intensive care

unit, training to become a supervisor,

which meant he’d been given a key to

the pharmacy — and its narcotics. To

beat the regular drug screens, he knew

the exact day each month that he

needed to stop shooting dope, stop

smoking pot, stop popping pills. But his

fix still had to come from somewhere.

So he found himself breaking into the

operating room.

Nitrous oxide. It wouldn’t show up

on the screens. He took care to mix in

enough oxygen.

‘‘Eventually,’’ he says, ‘‘they found me

unconscious in the operating room and I

couldn’t let go of the hose. And that’s

the night I got in trouble that last time.

I’d been on the nitrous about six hours.’’

Colleagues were in disbelief. John

Marshall, a guy who could walk in and

right away be pegged for bigger things

in nursing, had become a surprise

tornado under their noses.

‘‘It was a nasty, nasty scene,’’ he

says. ‘‘That’s when I hit my bottom and

I realized, ‘You’re gonna die if you

don’t stop.’ ”

♦ ♦ ♦ ♦ ♦

Feb. 25, 2012, New Orleans. It wasn’t

the first time Marshall had heard Allison

Bolin dig into this topic. Here at ENA’s

Leadership Conference, he sat in again

as Bolin, BSN, RN, CEN, CPEN, laid out

the warning signs of employee

substance abuse and drug diversion in

hospitals. Emergency nurses can be

particularly susceptible, Bolin cautioned,

because of their special risk factors: high

job stress, access to medications, a

tendency to feel invulnerable.

At the end of her presentation, Bolin

invited questions at an open

microphone. Marshall stood. He had not

a question but a story — his. He’d been

there. He’d been the nurse Bolin was

urging others to identify, to report, to

help, to save. He’d become a new breed

of nurse: one who’d widened his scope

Official Magazine of the Emergency Nurses Association 23

from helping patients to also helping

other health care workers escape the

nightmare he’d known first-hand.

The room applauded.

John Marshall hasn’t had a fix in 27

years, but he’s made a life of fixing. As

facilitator of the Mobile Professional

Group, with which he’s been involved

since 1987, he sits in every other week

with anywhere from six to 26 health

care professionals whose encounters

with drugs and alcohol have led them

into his circle. The group is run like a

12-step program, the same way Marshall

got clean. Meeting topics rotate. New

members are worked in as they come.

It’s a casual, safe, free place where

people who handle narcotics as part of

their jobs can find the peer support to

keep themselves straight.

It’s also non-punitive — a way for

nurses to manage their recoveries

without being put on probation by the

Alabama Board of Nursing.

‘‘Most states have some kind of

nondisciplinary program now,” says

Marshall, who didn’t have that option in

1985 and spent the next several years

on probation in Georgia and Alabama.

‘‘Usually it’s required that the person

call [the board] and report themselves:

‘I’ve got a problem, I need some help.’

If people wait until an employer calls

and says, ‘We’ve got somebody with a

problem,’ a lot of times they end up on

probation.’’

No one wants that. Probation opens

the door to legal consequences for

diversion or writing self-prescriptions. It

offers no anonymity. In Alabama,

Marshall says, it means ‘‘their license is

stamped with ‘probation.’ It goes out in

the state newsletter who’s in trouble

with drugs, where in the nondisciplinary

program, none of that’s done.’’

Some in Marshall’s group, after

reaching their crisis points, were

referred to him by the Alabama board.

Others were invited by active members

or pointed there by treatment centers.

Most who attend are nurses; he

currently has two from EDs. Doctors

have their own group for recovery —

the International Doctors of Alcoholics

Anonymous — but two or three docs

still come to Marshall’s meetings. He

has nurse anesthetists, a pharmacist.

He’s had surgeons, even veterinarians.

Some are there to satisfy the

nondisciplinary requirement after one

failed drug screening. Their problem is

that they used casually, not abusively,

and got caught. Some, like Marshall, are

there because they became true

chemical addicts, no longer wanting the

fix but physically needing it; they

‘‘crossed the wall,’’ as he puts it. That’s

the other end of the spectrum.

There’s a large middle area — nurses

who aren’t chemically dependent but

who face the grim risks of denial, relapse

and career derailment.

‘‘We have a disease that tells us we

don’t have it, that we’re OK, that we’re

too smart, that I should be well by

now,’’ Marshall says. ‘‘And that’s just the

nature of the disease of addiction — it’s

a liar. It’ll lie to you. So after you’re not

being monitored and you don’t have to

go after a while, if you happen to be

one of those people that hadn’t crossed

the wall, you kind of phase out.’’

His mission is to see that as many as

possible don’t. He stresses a spiritual

philosophy of finding a ‘‘higher power’’

— a touchstone bigger than the drugs or

alcohol. For some, that’s religion. For

some, it’s a symbol — a tree, for

instance, or perhaps the group itself. A

few in the group, long after rescuing

their careers in health care, continue to

attend meetings 10 or 15 years later.

Some have lived out their natural lives

as members.

‘‘With addiction,’’ Marshall says,

‘‘they say once a cucumber’s a pickle,

it’s always a pickle — it’s never a

cucumber again.’’

♦ ♦ ♦ ♦ ♦

By early 1985, John Marshall knew he

was a pickle, or what he’d later call

one. More aptly, he says, he was ‘‘a

nurse manager’s nightmare.’’ Three

years earlier, his first shot of Demerol

John Marshall in 1974 at the start of a career that fell into chaos a decade later.

Continued on next page

“I got to a point where it didn’t work anymore. I couldn’t do enough dope to feel good. I could do enough

to pass out and get sick, but I couldn’t stop.”

March 201324

had been 50 mg. Now 50 mg wouldn’t

touch him.

‘‘I got to a point where it didn’t work

anymore,’’ he said. ‘‘I couldn’t do

enough dope to feel good. I could do

enough to pass out and get sick, but I

couldn’t stop. I tried everything I could

do to stop, and I couldn’t stop.

‘‘The manager that fired me in the

ED [in 1984] told me, ‘You are not the

same person I hired.’ And I wasn’t. You

know, the meth made me crazy. So then

I thought it was just the meth — ‘It’s the

meth that’s doing it. As long as I just

drink beer and smoke pot, I’ll be OK.’ ’’

By February, less than six months

after his dismissal from that ED and his

short rehab stint, he had relapsed,

driven into a frightening tailspin by the

access to narcotics at his new hospital,

where he’d been hired as a relief

supervisor. He diverted more and more,

never denying patients their medications

but instead measuring out more so that

he could ‘‘save scraps.’’

‘‘Eventually I knew I was gonna get

caught,’’ he says. ‘‘I knew that. It wasn’t

a surprise.’’

The surprise, he says, came after his

final nosedive with the nitrous oxide,

when he returned to the treatment center

where he’d completed his first rehab.

‘‘Get out,’’ the addictionologist told

him. ‘‘I can’t help you.’’

Marshall, he said, had conned his

way through the program once already.

It got worse. The Georgia Board of

Nursing had been notified. The Drug

Enforcement Administration had been

notified. Marshall was looking at a

possible six to 10 years in jail.

‘‘And if you’re here when I get out

of group,’’ the addictionologist told him,

‘‘I’m going to have you arrested for

trespassing.’’

Marshall slumped in a chair, stunned.

Bottom was even lower than he thought.

The only morsel he was offered was

a phone number for a treatment center

in Atlanta, the Ridgeview Institute,

which specialized in recovery for health

care professionals.

So that’s where his recovery began.

He checked into a three-month

program at Ridgeview.

He stayed for six.

♦ ♦ ♦ ♦ ♦

The first year after rehab was the

hardest. Probation meant hospitals in

Atlanta didn’t want to talk to him. A

doctor he’d worked with during his

treatment offered him a job at a halfway

house for head-injury patients. That

gave him a foot back in the door as a

nurse, though ‘‘the only nursing thing I

really did was give Dilantin for the

seizures,’’ he says. ‘‘The rest of it was

trying to manage a community of

head-injury patients, which is a different

world all in itself.’’

Still, a chance was a chance. And

others would follow.

Another of Marshall’s former

counselors needed a nurse in recovery

to work in an alcohol-dependency

program at a Mobile hospital. That job

took him to Alabama — resetting his

five-year probation — in 1986. When

the hospital folded after a few months,

he decided to stay near the Gulf rather

than transfer north to Birmingham. But

finding work at another local hospital

proved tough.

‘‘They would look at my résumé and

go, ‘Oh, you were critical care — this is

good. Oh, you were a paramedic — this

is good. Oh, you’ve got emergency

— this is good,’ ’’ he says. ‘‘But then

they’d hit that last page about the drug

treatment, and it was like the paper

caught fire in their hands or something.’’

Committed to his recovery, Marshall

fell in with the Mobile Professional

Group. He remarried.

One hospital, Knollwood Park in

Mobile, snapped the pattern of rejection

and decided to take a chance on him.

He was hired to work in the head-injury

unit. He was still there in 1991 when

his probation was lifted and he again

was licensed to handle narcotics.

♦ ♦ ♦ ♦ ♦

Marshall’s job history since the late

1980s is the sort of career climb others

expected for him before his collapse.

His employment at Knollwood Park

evolved from a happy break to a

17-year stay until the hospital was sold.

From the head-injury division, he moved

to the emergency department, where he

eventually rose to ED nurse manager in

Marshall stands before the room to discuss his recovery and his work with the Mobile Professional Group after a presentation by Allison Bolin, BSN, RN, CEN, CPEN (right), during last year’s Leadership Conference in New Orleans.

Official Magazine of the Emergency Nurses Association 25

2000. He became house supervisor in

2003, then started with the Children’s

and Women’s Hospital in 2007.

Never far away was the group.

Marshall had made contacts in his

treatment that afforded him clean slates.

His end of the bargain, he realized, was

to advocate for others in turn. A nurse

in recovery whose license has been

revoked might list him as a reference on

a job application. He has been to court

on another nurse’s behalf in a child-

custody case.

‘‘The group helps me do that,’’ he

says. ‘‘We do things to help our

members get back on track in several

aspects of their life, not just in

employment. Somebody was there for

me when I was in trouble and needed

help, so now my job is when somebody

needs help, I’m there for them.

‘‘In my groups and meetings that I

go to with 12-step, when somebody

asks you to do something, you say yes.

These people call me 24/7.’’

Sometimes he has dreams that he’s

still using — the ol’ ‘‘drinkin’ and

druggin’ dreams,’’ he calls them. Though

he’s not in an emergency department

officially, he sees trauma. He sees

children going through chemotherapy.

Sometimes elements in his life don’t feel

balanced. Steps feel out of sync. That’s

when he makes a few calls, too.

Recovering and fixing go both ways.

‘‘I’m in recovery, but my disease is in

the parking lot doing pushups,’’

Marshall says. ‘‘I still do those things

because if I don’t do those things, I’m

going to be acting like a pickle again,

and I don’t know if I could live through

that. Twenty-eight years ago, I’d have

just taken something to change the way

I feel and keep on going. And I don’t

do that now.

‘‘And my life is so much better now,

truly a miracle. Staying high all the time

is a full-time job. When you wake up in

the morning and say, ‘Oh, my God,

what have I got? Have I got enough?

Where am I getting more?’, that’s a

full-time job. It’s so much easier now

living life on life’s terms.’’

His grown son from his first

marriage has seen his perseverance,

has seen him guiding others through.

He has a daughter, 23, who grew up

a witness to his recovery.

Life is good. His mornings are

only about one vice now — coffee.

He asked a counselor about that

once. Was it a problem?

‘‘As long as you’re not shootin’ up

freeze-dried Folgers,’’ he was told,

‘‘you’ll be fine.’’

Readers can contact John

Marshall at jtaddictions@aol.com.

Workplace Violence Prevention Online Courses

Now available free to ENA members are three webinars that discuss violence in the workplace and mitigation strategies.

FREE for ENA

Members

Stay tuned for upcoming workplace violence educational opportunities.

Thank you to our sponsor

These webinars are brought to you by

In collaboration with

Visit www.ena.org and sign up today.

Non-members can purchase these continuing education courses by visiting ENA’s LMS

Not a member? Join ENA today!

WVP_3by3.indd 1 2/7/13 10:45 AM

ENA conference faculty presenter

Allison Bolin, BSN, RN, CEN, CPEN,

a rapid-response nurse at Dominican

Hospital in Santa Cruz, Calif., offers

these red flags for substance abuse

or drug diversion in the ED:

Behavioral extremes: Some

with substance-abuse issues become

sloppy and don’t seem to care about

their work. Others, particularly those

diverting drugs, become hypervigilant,

paying extra attention to who is

receiving medications, offering to

medicate other nurses’ patients and

spending more time than normal in

the dispensing areas.

Personality changes: Substance

abusers tend to withdraw socially

and show increased irritability.

Absenteeism: Often seen in

employees with alcohol problems.

Coming in on days off or

frequently volunteering for extra

shifts: Often seen in drug diversion.

Fishy reports: Most hospitals

have anomalous usage reports that

identify who’s dispensing which

drugs the most. Abnormally high

numbers can indicate diversion.

Difficult life problems: Has

your co-worker had a recent back

injury? Is he or she going through a

divorce? These kinds of situations, in

combination with some of the signs

above, can point to a larger problem.

If you’re worried that a colleague

is battling substance abuse, report

your suspicions to your supervisor (it

could save a life, Bolin stressed) and

let the department proceed according

to policy. If you’re a supervisor, she

said, make sure you have the

documentation to support a

reasonable suspicion and involve the

human resources department before

confronting the employee.

Often the most respected nurses

are the ones most in trouble, Bolin

said. She herself has been in recovery

since 1990 and runs a support group

for nurses in two counties.

‘‘So many nurses don’t even

recognize it could be a problem,’’

she said. ‘‘We’re not any less

immune because of our education.

In fact, we’re probably at greater

risk, especially in the emergency

department.’’

Josh Gaby

Is Your Co-Worker in Trouble?

March 201326

Updated Administrative ProceduresThe Administrative Procedures have

been updated with two items, effective

immediately:

1. TNCC Reverification courses can

continue to be held; however no

contact hours can be awarded for

attending the course.

2. Non-RN health care providers

who work in an emergency setting can

participate in the written and skill

station testing of both the ENPC and

TNCC Provider courses. The non-RN

health care worker who attends a

Provider course will receive a

certificate of attendance with the

appropriate number of contact hours,

but will not receive a verification card

or verification status.

Please refer to the Administrative

Procedures posted on the TNCC and

ENPC pages of www.ena.org for

further details.

ENPC Provider Manual ErrataAll ENPC 4th Edition Provider

manuals that are shipped will have an

errata document included, until the

next reprint is needed. This errata

document can also be found at:

www.ena.org/coursesandeducation/

ENPC-TNCC/enpc

We anticipate reprinting the ENPC

4th Edition Provider manuals in the

spring. We appreciate everyone’s

assistance in identifying these changes.

ENPC 4th Edition Instructor UpdateThe deadline for completing the

ENPC 4th Edition Instructor Update is

Feb. 28. The update can be found on

your Personal Learning Page under the

Courses and Education tab at www.

ena.org. It is necessary to indicate that

you reviewed the video/modules

before you can access the 50-question

exam. This can be found under the

Assessment tab within each module.

ENPC 4th Edition InformationENPC course directors received an

e-mail in November 2012, providing

information regarding corrections

being made to the ENPC 4th Edition

Instructor Supplement and the course

slides. Corrected copies of the

instructor supplement will be provided

to all instructors who had previously

purchased it at no additional charge.

Shipments started in January. Those

instructors who had previously

purchased a downloadable instructor

supplement are being contacted to

advise them that they can now

download a corrected copy.

All course directors who had

previously requested and received the

4th edition CD-ROM will be

automatically sent a new copy as well.

The Course Directors Only section of

www.ena.org reflects the updated,

corrected information.

The new CD-ROM and Course

Directors Only web page will include

a practice test and answer key. This

will help the students prepare for the

provider course. Also included in the

instructor course folder are the scored

teaching scenarios related to the

examples played during the instructor

course from the course DVD.

TNCC Reverification Courses TNCC course directors were notified via

e-mail in November 2012 that the ENA

Board of Directors met on Oct. 24,

2012, and decided that the 6th edition

TNCC Reverification courses can

continue to be held after Dec. 31, 2012.

As of Jan. 1, however, no contact hours

can be awarded for attending a TNCC

Reverification course. This decision was

made after receiving quite a bit of

feedback from course directors

indicating that the availability of the

one-day reverification course option,

even without the ability to award

contact hours, would provide a much

needed option for many institutions.

First AnniversaryECourseOps is celebrating its one-year

anniversary as course directors

increasingly take advantage of its

capabilities. About 65 percent of the

course applications submitted to ENA

come through eCourseOps. We have

received a lot of very positive

feedback indicating that eCourseOps is

easy to use for adding a course,

ordering books and paying invoices. A

very popular feature is the “copy”

course icon that allows instructors to

create a new course by copying an

existing course while making

necessary small changes, such as new

course dates.

Log in to www.ena.org to access

eCourseOps via the Courses &

Education tab’s dropdown menu.

There are frequently asked questions

and help documents on the landing

page. Course Operations is available

for assistance at 800-942-0011 or

courseops@ena.org. If you haven’t

yet used eCourseOps, give it a try. We

think you’ll like it.

Your Input is WelcomeCourseBytes is the official

communication to all TNCC and ENPC

directors and instructors. Topic ideas for

future issues and feedback are welcome

at CourseBytes@ena.org.

COURSE BYTES

March 201328

New Jersey ENA State Council New Jersey ENA will hold the 35th

Annual Emergency Care Conference,

March 13 – 15. This is the third

largest emergency care conference

in the nation. For more information,

contact Cheryl Newmark, RN, NJ

ENA media relations, at cgnrn75@yahoo.com.

Share your state council and chapter news with emergency

nursing colleagues from around the world in State

Connection. Highlight council and chapter activities,

announcements and other initiatives by submitting a short

article to ENA Connection.

Suggested topics include:

• Volunteer opportunities to solicit, encourage and welcome

members to get involved in your state or chapter

• State council or chapter successes, achievements

or accomplishments

• Membership drive campaigns and updates

• Award announcements or call for awards

• Innovated projects, ideas or best

practices

Articles should be under 400

words and will be edited for length

and clarity. High-resolution digital

photos or images that can be scanned

are welcome with your submission.

State Connection also offers an opportunity to announce

upcoming educational programs, state council or chapter

meetings or special events in the “Meetings and Events”

section. Include the following information with your

submission:

• State/Chapter name

• Event/Conference name

• Date of the event

• Time

• Location

• Presenter(s)

• Website or contact information

To submit an article or event or for more information,

contact us at connection@ena.org.

ENA STATE CONNECTION

school to obtain my master’s degree

and then encouraged me to apply for

her position when she left. But more

important than her words were her

actions. I witnessed her every day

modeling the behaviors of someone I

wanted to become: She was graceful

under pressure, politically savvy and

had the respect of the emergency

department staff. I am just sorry

that I never had the opportunity to

thank her.

Two-Way StreetWhat does it take to be a good

mentee? The mentee should drive the

relationship. As the mentee, you must

be comfortable in communicating

openly with your mentor. You must be

clear about what you expect to

accomplish by partnering with this

person. Be committed to the

mentoring relationship and don’t forget

to acknowledge your mentor.

One of my goals as ENA president

is to provide more opportunities for

mentoring within our organization. We

already have one great mentoring

program in EMINENCE. The

EMINENCE program is designed to

pair ENA members with experienced

Academy of Emergency Nursing

fellows. AEN fellow mentors volunteer

their time and talents to work with

up-and-coming ENA members.

This provides a wonderful

opportunity to share knowledge and

experience with the next generation of

emergency nurse leaders.

The ENA Board of Directors has

implemented a new program to pair

an emerging leader with a board

mentor. The mentors will spend the

year helping their mentee develop

their leadership goals and determine

an action plan for national ENA

contributions.

I encourage all of you to

acknowledge your mentors, find a

mentor or become a mentor.

Resources

Loretto, P. (n.d.). Top 10 Qualities of a

Good Mentor. Retrieved from www.

interships.about.com

Roberts, A. (1999). Homer’s mentor:

Duties fulfilled or misconstrued.

Retrieved from www.peermentor.net.

Letter From the President Continued from page 3

‘‘Mentoring is a brain to pick, an ear to listen

and a push in the right direction.”

John Crosby

New ENA monthly offering for FREE Continuing Education with contact hours for our members.

• Available March 1 GU: It’s More Than Just P, 1.0 contact hourMichael D. Gooch, MSN, RN, CEN, CFRN, ACNP-BC, FNP-BC, EMT-P

Don’t miss out on enhancing your education by registering and completing the offering. Go to www.ena.org/FreeCE for additional free continuing education opportunities.

The Emergency Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

FreeCEConnection_March.indd 1 1/18/13 9:37 AM

March 201330

The AEN EMINENCE ProgramThe Academy of Emergency Nursing is proud to report its fifth group of mentors

and mentees are currently working on projects for the 2012-2013 program. The

EMINENCE program is designed to pair ENA members with experienced Academy

fellows. AEN fellow mentors volunteer their time and talents to work with

up-and-coming ENA members. This provides a wonderful opportunity to share

knowledge and experience with the next generation of emergency nurse leaders.

Applicants submit project descriptions and are matched with fellows who have

expertise in the subject matter. Project topics include professional presentation,

writing for publication, research, educational conference planning and program

development. Upon acceptance into the program, mentees pay a $100

administrative fee.

The following mentee/mentor pairs are participating in the 2012-2013 program:

Mentee Mentor Area of InterestMeredith Addison, MSN, RN, CEN

Kiefah Awadallah, MSN, BS, RN

Kimberly Brandenburg, BSN, RN, CEN

Colleen Connors, MSN, RN, CEN

Hershaw Davis Jr., BSN, RN

Siegfried Emme, MSN, RN, NP-C, CEN,

CCRN

Michael Franks, BSN, RN, CEN

Marites Gonzaga-Reardon, MSN, RN, APN, CEN, CCNS

Jerry Jones, MBA, BSN, RN

Jennifer Morris, RN, CPEN, CPN

Curtis Olson, BSN, BA, RN, EMT-P, CEN

Charlann Staab, MSN, RN, CFRN, CHC-C

Kathy Van Dusen, BSN, RN, CEN

Belinda Watkins, BSN, RN, CPEN

Thelma Kuska, BSN, RN, CEN, FAEN

Rebecca Steinmann, MS, RN, APN, CEN, CPEN, FAEN

Patricia Kunz Howard, PhD, RN, CEN, CPEN, NE-BC, FAEN

Anne Manton, PhD, APRN, FAEN, FAAN

Susan Hohenhaus, LPD, RN, CEN, FAEN

Jean Proehl, MN, RN, CEN, CPEN, FAEN

Gordon Gillespie, PhD, RN, PHCNS-BC, CEN, CPEN, FAEN

Gail Lenehan, EdD, MSN, RN, FAEN, FAAN

Andrea Novak, PhD, RN-BC, FAEN

Jeff Solheim, MSN, RN-BC, CEN, CFRN, FAEN

Laura Criddle, PhD, RN, CEN, CPEN, FAEN

Carole Rush, MEd, BSN, RN, CEN, FAEN

Diana Meyer, DNP, MSN, RN, CEN, CCRN, FAEN

Harriet Hawkins, RN, CPEN, CCRN, FAEN

Trauma Systems

Program Development

Injury Prevention (SBIRT)

Program Development

Professional Presentations

Program Development

Writing for Publication

Writing for Publication

Educational Conference Planning

Professional Presentations

Writing for Publication

Writing for Publication

Advanced Practice Role Development

Program Development

If you would like to participate in the 2014-2015 EMINENCE program, watch for application information posted at

www.ena.org/about/academy/EMINENCE in mid-March 2013. Applications are due April 30.

Provider Manual

Fourth Edition

Provider Manual

Fourth Edition

ISBN 978-0-9798307-4-7

915 South Lee Street

Des Plaines, IL 60016

Emergency Nursing

Pediatric Course

The Emergency Nurses Association is proudto present the release of the 4th edition ofthe Emergency Nursing Pediatric Course.It has been revised and updated, evidence-based, and continues to incorporate various teaching and learning styles.

• A portion of the course will be presented in an online format through ENA’s Center for e-Learning.

• Pediatric Clinical Considerations is nowcase-based using group discussion.

• The adolescent patient is addressed witha separate chapter and lecture.

• Triage is now Prioritization with a focus on the process, rather than the place.

Upon successful completion of ENPC, RN participants are veri� ed for four years, receive a veri� cation card and earn up to 16 contact hours.

This course brings the emergency nurse a resource for treating the pediatric patients arriving to emergency

departments every day.

To verify why ENPC is right for you and toview course schedules, please visit

www.ena.org/coursesandeducation

departments every day.

The Emergency Nurses Association is

accredited as a provider of continuing nursing

education by the American Nurses Credentialing

Center’s Commission on Accreditation.

March 201332

AC13

ENA Member Finds Paradise Needs Good Teachers

Offering educational and networking opportunities for professionals caring for emergency patients.

For more information, visit www.ena.org.

Lee Singer, RN, CEN, is a woman of many talents. An

emergency nurse since 1987 and an EMT since 1978, she is a

member of her local disaster medical assistance team, an avid

surfer and a concert flutist. She is a provider for the Trauma

Nursing Core Course and an instructor for the Emergency

Nursing Pediatric Course and for a Rhode Island emergency

medical services training program. She has saved lives on

both coasts, from conducting air evacuations in California to

assisting an urban search and rescue team in Rhode Island,

performing assessments on people stranded in their homes

after Hurricane Sandy devastated Misquamicut last October.

In 2012, Singer extended her emergency care and training

reach to St. John in the U.S. Virgin Islands. During a

vacation, Singer and her boyfriend, who is also an EMT,

were on a St. John beach when they met a member of the

local rescue squad.

‘‘I asked her what kind of training she had, and she said

they were always looking for people to do training,’’ said

Singer, an emergency department charge nurse at South

County Hospital in Wakefield, R.I.

Six months later, Singer returned to St. John for a week to

train rescue workers, including EMTs from the island and

from St. Thomas, as well as members of the National Parks

Department. Two-thirds of St. John is dedicated park space.

The rescue workers’ usual training consisted of videos from

their training officer, some outdated lectures and occasional

EMT training by instructors from the U.S.

Singer incorporated TNCC and ENPC information into her

training lectures, as well as an extensive review of anatomy

and physiology.

‘‘I’m a firm believer that if you know what you’re looking

at and what parts you’re looking at, you can understand

what’s going on in a trauma situation or a burn situation,’’

Singer said. ‘‘We did a lot of the basic scene material. I used

the TNCC method for airway, breathing and circulation, and

I taught them the CIAMPEDS mnemonic we use in ENPC for

complaint, immunization and allergies, which they loved.’’

As a beach vacation destination, St. John sees its share of

drunk-driving traumas, water injuries and coral cuts, while

other islands also see surfing injuries. The local population

Vocation in Her Vacation

By Amy Carpenter Aquino, ENA Connection

marketplace ExprEssNEW! Comprehensive systematic review for Advanced Nursing practice Cheryl Holly, EdD, R Susan Salmond, EdD, RN, FAAN, Marie K.Saimbert. BPharm, MSN, MLIS, RN (Editor)

In an age of rapidly expanding knowledge, it is crucial for health professionals to stay abreast of the most current evidence-based information when making clinical decisions. The text sets forth a rigorous, step-by-step approach to the process of conducting a literature search, including both quantitative and qualitative studies, as well as “grey” literature. It describes how to extract and synthesize the most relevant data, how to integrate systematic reviews into practice, and how to disseminate the results.

Take $10 off during the month of March!

retail (Non-Member) price: $70.00ENA Member price: $59.00

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360 pagesISBN: 9780826117786© 2011Weight: 2 lb.

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Official Magazine of the Emergency Nurses Association 33

suffers from a very high incidence of asthma, as well as some

obesity and those comorbidities, such as diabetes and high

blood pressure, in addition to some alcoholism, Singer said.

In addition to addressing those emergencies, Singer said

she incorporated training with familiar prehospital elements,

such as the MIVT report (mechanism of injury, vital signs

and treatment) and the PQRST (provokes, quality, radiates,

severity and time) pain pathway assessment.

‘‘You need to dig below the surface,’’ she said. ‘‘This

person had a broken bone, but you need to dig underneath

this, so I would go into the structures and say, ‘OK, this is

what happened, this person fell over the handlebars, and

you see a bruise on this side. What do you suspect? What do

you think is under there?’ And they start more critical

thinking, and when they really caught on it was wonderful.’’

Singer’s students benefitted so much that the training

officer asked her to return this April. Singer plans to bring

‘‘tons of new information that is going to blow their minds,’’

including pediatric standards and a toxicology lecture on

bath salts and some of the poisonous plants used by locals

in folk medicine treatments.

A ‘‘win-win’’ exchange is how Singer described her

Caribbean teaching experience. While her students gained

new knowledge and skills, Singer said she returned with

renewed energy to pursue her own education and

certifications.

‘‘I’ve gotten better in my practice as a nurse also,’’ she

said, ‘‘by doing some of the research and putting it into

practice. I’ve learned a lot of tricks of trade from the rescue

down there. For instance, they do what they call high-angle

rescues, because it’s all pretty mountainous, so I can take

some of that back for our EMTs.’’

Singer encouraged other ENA members to remain open to

new prospects, wherever they are.

‘‘If you have an opportunity, you’d better take that

opportunity and do the best that you can with it,’’ she said.

‘‘I would offer that not just to nurses but to anybody. ‘Oh,

the places you’ll go,’ as Dr. Seuss wrote.’’

ENA member Lee Singer, RN, CEN, with Bob Malacarne, training officer for the St. John rescue corps, in St. John.

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